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Post-operative epicardial pacing and hemodynamic support among aortic valve patients.

机译：主动脉瓣患者的术后心外膜起搏和血流动力学支持。

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摘要

Background: Burdens of cardiac and extra-cardiac co-morbidity, coupled with complex surgical and anesthesia interventions, require intense intra- and post-operative monitoring and care to optimize outcomes. Despite a need for clinical guidance, a paucity of studies explores post-operative temporary epicardial pacing, vasopressor and inotropic medication use among aortic valve replacement (AVR) patients. Purpose: To better target post-operative interventions for AVR patients, associations between pre and intra-operative risk factors (e.g., chronic conditions, QRS duration and medication use), cardiovascular interventions (pacing and hemodynamic support), and post-operative outcomes (morbidity and resource utilization) were explored. Methods: Medical records of 195 patients having an AVR from 11/2007 to 10/2011 were reviewed from a single academic medical center. Cross-sectional analyses used multivariable analyses to identify factors associated with temporary epicardial pacing, acute kidney injury, and length of stay. Results: Patients were equally represented in gender, nearly all (88%) Caucasian, with a mean age of 67.7 years (SD=12.9). More than a third of patients (36%) were paced at time of bypass separation; 13% of the total continued to be paced after 7 a.m. of post-operative day-1. Females were more likely to be paced in the CSICU (OR = 3.08, 1.30-7.31), while pre-operative co-morbidities, ejection fraction, QRS duration, stain or ACE/ARB uses and CPB time did not have an independent effect. Post-operative pacing and level of hemodynamic support were not associated with day-2 renal function. Prolonged CSICU stays were associated with female gender, age>75 years, and if both epicardial and hemodynamic supports were used as compared to no cardiovascular support. Prolonged hospital stays were associated with prolonged CSICU stay > 4 days and age>75 years. Conclusions: Post-operative management of AVR patients has considerable variability. While it would be useful to pre-operatively identify patients requiring extended post-operative pacing and hemodynamic support, no co-morbidities were associated. Additional studies are needed to better risk stratify AVR patients so interventions can be targeted so the care team can better plan care and monitor progress.
机译：背景：心脏和心脏外合并症的负担，再加上复杂的外科手术和麻醉干预措施，需要对术中和术后进行严格的监测和护理，以优化治疗效果。尽管需要临床指导，但很少有研究探索主动脉瓣置换（AVR）患者的术后临时心外膜起搏，升压药和正性肌力药物的使用。目的：为了更好地针对AVR患者进行术后干预，术前和术中危险因素（例如，慢性病，QRS持续时间和药物使用），心血管疾病干预（起搏和血液动力学支持）和术后结果之间的关联（发病率和资源利用）。方法：从一个学术医疗中心审查了11/2007年至10/2011年间195例AVR患者的病历。横断面分析使用多变量分析来确定与临时心外膜起搏，急性肾损伤和住院时间有关的因素。结果：患者的性别平等，几乎所有（88％）白人，平均年龄为67.7岁（SD = 12.9）。超过三分之一的患者（36％）在旁路分离时进行了起搏；术后第1天早上7点后，继续进行总调整的13％。女性更有可能在CSICU中起搏（OR = 3.08，1.30-7.31），而术前合并症，射血分数，QRS持续时间，染色或使用ACE / ARB和CPB时间并没有独立的影响。术后起搏和血液动力学支持水平与第2天肾功能无关。 CSICU长期住院与女性，年龄大于75岁以及是否同时使用心外膜支持和血液动力学支持（而不使用心血管支持）有关。延长住院时间与CSICU延长住院时间> 4天和年龄> 75岁有关。结论：AVR患者的术后处理存在很大差异。虽然在术前确定需要延长术后起搏和血流动力学支持的患者会很有用，但没有合并症。需要进行其他研究以更好地对AVR患者进行风险分层，以便有针对性地进行干预，以便护理团队可以更好地计划护理并监测进展。

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  • 作者

    Brady, Barbara.;

  • 作者单位

    University of Maryland, Baltimore.;

  • 授予单位 University of Maryland, Baltimore.;
  • 学科 Health Sciences Nursing.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 154 p.
  • 总页数 154
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 地球物理学;
  • 关键词

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